Zak Cason had the classic signs of ADHD. He had trouble focusing in school, received poor grades and would often interrupt the classroom with his musings, even leaving the classroom if he was bored to wander the halls.
After several years of this, Cason, a former Sunrise resident whose family relocated to Maryland, was finally diagnosed with ADHD — attention-deficit hyperactivity disorder — in 2005 by a school social worker. He was 7.
Cason was then referred to a psychiatrist, who set about searching for a medication to relieve his symptoms. In total, Cason tried eight different drugs, including the traditional first line of defense, Ritalin, then Adderall and other newer drugs.
Cason’s story is far from unusual. What was once labeled ADHD and is now called simply ADD — attention-deficit disorder — affects up to 15 percent of the 17-and-under population in certain states. In fact, approximately 11 percent of children 4 to 17 years of age — 6.4 million kids — have been diagnosed with ADHD as of 2011, according to the Centers for Disease Control and Prevention.
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Like autism, ADHD affects boys at a higher rate than girls — more than two to one, according to the CDC.
The disability, at times known by various names, began sparking significant attention in the late 1960s. At the time, children who exhibited hyperactivity along with the other symptoms were labeled ADHD, while those without hyperactivity were simply known as ADD kids.
By the late 1990s, as the condition skyrocketed, major research was being done on ADD, not only in the United States but throughout the world. That’s when questions began to be raised over whether the prevalence of ADD was sharply rising or whether there was more awareness of the disorder and specialists available to treat it.
“The question remains: Are we overdiagnosing ADD?” said Dr. Carlos Gadia, director of the neuropsychiatric disorders program at Nicklaus Children's Hospital Dan Marino Center in Weston. “It seems we are dealing with both overdiagnosis and underdiagnosis.”
In large metropolitan areas, where child psychiatric specialists abound, there appears to be a tendency to overdiagnose ADD, Gadia said, while in small, rural areas that lack specialists and the necessary health insurance for patients to obtain treatment the tendency appears to be to underdiagnose.
“In lower socio-economic areas, there is a much higher tolerance for ‘badly behaved kids’ rather than ‘this is a child with ADD,’ ” Gadia added. “There’s a tendency to say ‘this child just needs discipline’ when that may not be the case at all.”
In fact, ADD rates vary greatly from state to state. The national rate is 9 percent. In Florida, the rate is 11 percent; in California, 6 percent. A clump of states in the South and Midwest have a whopping 15 percent rate, which has baffled doctors.
“This indicates there is overdiagnosis in areas,” Gadia said. “This also holds true for autism.”
There is also a gender bias associated with the disease, notes Gadia. While a girl who sits daydreaming in class might be overlooked, a boy doing the same thing may be tagged for ADD.
Of course, just exhibiting certain symptoms of ADD doesn’t necessarily merit a diagnosis. The disease has to also impair a child’s functioning. Historically, the diagnosis of ADD is made at about 6 years old, although some children have been diagnosed as early as 3, 4 or 5. For younger children, behavior therapy is recommended as the first line of treatment.
The question remains: Are we overdiagnosing ADD?
Dr. Carlos Gadia, associate director of Joe DiMaggio Children’s Hospital in Hollywood
Allison Chlimper’s experience was a little different from others. For one, the North Miami Beach resident wasn’t diagnosed until she was 10. And her symptoms were not typical for ADD — she had an uncontrollable need to laugh and had no filter for her words.
“I literally could not stop laughing,” said Chlimper, now 30.
Additionally, Chlimper’s reading comprehension was poor, although, inexplicably, she excelled at math. She also experienced higher energy levels — the reason ADD-type drugs such as Ritalin and Adderall are often abused by high school and college students.
Chlimper’s parents were quick to notice her symptoms and took her to a psychologist for testing. She was prescribed Ritalin., the drug of choice at the time. Later on, Chlimper was put on drugs that were geared more to older adolescents, such as time-released medications.
Chlimper eventually graduated to Adderall, the drug many adults take, and took that until she became pregnant. Now a mother of two, including a child she is nursing, Chlimper immediately dropped the drug once she began nursing.
“I grew out of the laughter thing, thank God,” she said. “But I still have the lack of focus. I have no filter. I will say something out of the blue.”
Chlimper, who works at home in the medical field, hopes not to return to the medication after she is done nursing her children. She doesn’t like the side effects, including depression, although her husband would prefer that she remain on them because they can have lucid discussions.
“It takes away your emotions,” she said. “You feel flat all the time.”
Yet Chlimper, who moved here from Orlando a year-and-a-half ago, says she can see that the drug has positive effects.
Chlimper is one of about 25 percent of ADD patients who continue taking medication into adulthood, Gadia said. As adults, those with ADD may often exhibit impulsive behavior, get into car accidents and fail to sustain adult relationships. Decades after it hit the market, Ritalin is still the drug of choice for ADD, although it is not effective for 25 percent of patients.
While drugs are still the preferred treatment, doctors have recently found studies that show allergies to food colors may play a role in ADD. Researchers also have studied how genetics influences ADHD and are looking into links between ADD and lead exposure, brain injury, alcohol and tobacco use during pregnancy, premature delivery, and low birth weight.
An earlier version of this story had the wrong title for Dr. Carlos Gadia.
Signs and Symptoms
It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors.
A child with ADHD might:
▪ Have trouble focusing and finishing tasks
▪ Forget or lose things a lot
▪ Squirm or fidget
▪ Talk too much
▪ Have trouble organizing tasks and activities
▪ Have a hard time resisting temptation
▪ Be easily distracted
▪ Leave seat in situations where seating is expected
▪ Interrupt or intrude on others
Source: Centers for Disease Control and Prevention